Imagine you’re performing emergency surgery on a patient who is losing blood from a torn blood vessel deep in his belly. You are elbow-deep in blood. Every heart beat deepens the crimson puddle in his belly. Soon there won’t be enough left in his veins to sustain life. Your heart is racing as you cast around for solutions. Just then, a well-meaning colleague passes you a bandaid.
Such is the case with physician wellness today.
Reports increasingly recognise an epidemic of burnout and depression among physicians. This includes young physicians in training. The medical community is talking more and more about the high rates of suicide among its own. With increasing awareness, physician wellness and resilience programs have mushroomed across the country. Increasingly, physicians are reaching for yoga mats, reflecting on their experiences in groups, and sharing written accounts of their vicissitudes. Stigma against physicians needing mental health services is waning, albeit slowly. These changes are timely and important.
But they aren’t enough.
Focusing all our energies on wellness programs while doing nothing about the structural violence against physician wellness is the equivalent of putting a bandaid over a haemorrhaging artery. It’s not a lasting solution. It is time for us to figure out why medical training and practice often stamps out joy from the lives of the idealistic and driven individuals who choose medicine as a calling. I believe thoughtful large-scale structural changes are necessary to change the experience of physicians and trainees.
This is why I was excited to speak to Robyn Symon about her upcoming film “Do No Harm.” Robyn, a two-time Emmy Award-winner, and an accomplished writer, producer/director, and editor, first became acquainted with the high rates of physician suicide in 2014 when two promising physicians died by suicide in New York City within three months of starting their internships. Since then, Robyn has spoken to leaders in medicine as well as physician trainees to understand what puts physicians at risk of suicide and the structural changes that could mitigate the risks. She discusses issues ranging from common myths about sleep deprivation to nuanced critiques of recent studies that have led to the re-institution of 28-hour calls for interns.
Far too often, the magnitude of the physician burnout and suicide can overwhelm commentators and push them into hyperbole. Such impassioned advocates can sometimes call for the dismantling of the entire medical system without providing implementable alternatives. This is the equivalent of ripping out the bleeding artery entirely from the body instead of fixing the tear. Furthermore, scathing critiques that deplore the practice of medicine as “torture” and “abuse” can often become maladaptive. Such commentary can quickly become a self-fulfilling prophecy by leavings its intended audience with a jaundiced view of their lives, their profession.
Based on our conversation, Robyn has a more balanced approach. She also understands a discussion of physician distress needs to be independent and free of financial motivation. Indeed, Robyn has rejected some sponsorship offers from some profit-oriented entities in exchange for editorial control. The team behind the film has started a kickstarter campaign to keep the movie independent. I encourage everyone to contribute. I certainly shall.
It’s time to sew up the bleeding artery and stop its spasmodic torrent. In December, Robyn’s film will show us where to put the first stitches.
Disclosure: I have no financial conflicts of interest. Nor have I received any remuneration or perquisites for writing this independent essay.